Question

compare and contrast HMOs, PPOs, and EPOs.

Answer 1

HMO

HMO stands for health maintenance organization.
It requires you to select a primary care physician (PCP) who acts as "gatekeeper." Think of your PCP as your personal health-quarterback, strategically coordinating all of your care and providing for your basic healthcare needs. If you ever need to see a specialist or require a diagnostic service (such as a blood test), you will need a referral from your PCP. Your referral will always be to a provider within your HMO network. If you choose to see a doctor outside of the network or without a referral, you will generally have to pay all costs out-of-pocket unless it is a true medical emergency or you have no other options. With an HMO, your physician network is local.

PPO

PPO stands for preferred-provider organization. It is a health plan with a “preferred” network of providers in your area.  You usually don’t have to select a PCP in a PPO plan, and you can choose from more healthcare providers than an HMO because PPO networks are usually larger. If you see a “preferred” (or “in-network”) provider, you will only be responsible for paying a portion of the bill (according to your plan's coverage structure). If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an “in-network” provider, but most plans will still cover a portion of the bill. With a PPO, you will have access to out-of-state providers that are considered in-network. The main benefit of a PPO is flexibility, but it does come at the cost of higher premiums and a deductible that you will have to pay before your insurer starts paying for care.

EPO

An EPO or “exclusive provider network” is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO. Like a PPO, you do not need a referral to get care from a specialist. But like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan's network. An EPO is a good option if you want to see specialists without a PCP referral within your network.